New pharmacy kamagra australia online viagradirect.net with a lot of generic and brand drugs with mean price and fast delivery.

Microsoft word - niamh geary (1)

Assistive Technology through the Progression of a Degenerative Neurologic Disease: An Exploration of Best Practice. Purpose:
Certified Assistive Technology Training Course 2012
Assistive Technology and Specialised Seating Department,
Central Remedial Clinic, Clontarf, Dublin 3.
Contents
2. Overview of Assistive Technology and Specialised Seating Service in the
3. Overview of Degenerative Neurologic Diseases
4. Research in Assistive Technology and Degenerative Neurologic Diseases
5. Computer access & Degenerative Neurologic Diseases
6. Powered mobility & Degenerative Neurologic Diseases
7. Environmental Controls & Degenerative Neurologic Diseases
8. Communication Devices & Degenerative Neurologic Diseases
9. Key Considerations for Best Practice in Equipment Prescription
Acknowledgements
I would like to acknowledge all the help and support of the wonderful and
inspirational staff of Assistive Technology & Specialised Seating Department in the
Introduction
As a recent employee in the Assistive Technology & Specialised Seating Department
(ATSS) in the Central Remedial Clinic (CRC) I have chosen a project that is linked to
my previous role as an occupational therapist in elderly care including progressive
I chose to investigate current research and identify current practice including
commonly prescribed devices in the area of adults with a progressive neurological
disease. In this assignment I will outline the service offered by the ATSS
Department. I will briefly discuss the conditions commonly seen along with their
symptoms. I will summarise the findings of a literature search and finally discuss the
devices that are commonly prescribed and the key considerations for equipment
Overview of the ATSS Department.
The Assistive Technology and Specialised Seating Department in the Central
Remedial Clinic provides a quality assessment service to people with physical
disabilities in the area of Assistive Technology (AT). In addition it offers a service to
adults with a diagnosis of a degenerative neurological disease. These diseases can
include Motor Neuron Disease (or amytrophic lateral sclerosis), Multiple Sclerosis,
Huntington’s Disease and Parkinson’s Disease (Progressive Supranuclear Palsy).
AT consists of a broad range of devices, technical aids and strategies, which can
help solve problems faced by people with disabilities in every day life.
The department strives to offer people alternatives and options to facilitate their
personal independence in everyday living. Today there is a wide range of technology
devices that have become smarter, smaller, lighter and more affordable and it is
often simply a lack of understanding of how our environment can be adapted and
modified that is the greatest barrier for people with disabilities in our society.
A multidisciplinary team of assistive technology advisors brings experience from a
variety of backgrounds including, engineering, occupational therapy, speech and
language therapy, ICT and education. The team operates both a centre based and
national outreach service. Nationally, their work is complemented by a network of
regionally based clinical technicians who are available to offer support and follow up
to people in their local environments. As far as possible, the team work in
partnership with local agencies to provide person centred responses.
Overview of the types of Degenerative Neurologic Diseases
For the purpose of this assignment I will focus of the clients with a diagnosis of a
degenerative neurological disease. I will outline the key characteristics of a number
of degenerative progressive neurological disorders that I have been involved in their
Motor Neuron Disease (MND) is an incurable neurological condition that selectively
affects the motor neurons, the cells that control voluntary movement activity; walking,
talking and swallowing. MND presents its self in various ways depending upon the
muscle fibers which degenerate initially. There are two types; limb onset and bulbar
onset. Limb onset involves progressive muscle weakness and wasting, and can also
include fasciculation and changes in muscle tone. The Bulbar or brainstem type,
involves symptoms including speech and swallowing difficulties. Wasting of muscles
in the upper limbs, stiffness of the lower limbs and wasting of the tongue muscles
affecting speech and swallowing. There are approximately 300 people living in
Ireland at any one time with a diagnosis of MND. (IMNDA 2012)
Multiple Sclerosis (MS) is also a progressive neurological condition that affects the
central nervous system (CNS). This is the switch board responsible for sending
electrical messages along the nerve fibers to various parts of the body. Healthy
nerve fibers are insulated with myelin, in MS the myelin breaks down and distorts or
blocks the message flow. There are four different types of MS, relapsing remitting
MS, secondary progressive, benign and primary progressive. The symptoms
typically are muscle spasm and stiffness, low mood and depression, memory and
other cognitive impairments, fatigue and tremors. There are approximately 7,000
people in Ireland with a diagnosis of MS. (MS Ireland 2012)
Huntingtons Disease (HD) is a hereditary incurable neurological disorder that causes
brain cell degeneration leading to physical cognitive and emotional deterioration.
Symptoms can vary and may include involuntary jerky movements of the limbs, face
and trunk, increasing difficulty with communication and swallowing, mental turmoil
(depression and apathy) and finally problems with planning, organising, initiation as
well as personality changes. As for all degenerative neurological disorders
interventions must be timely and responsive to the changing needs of the individual
and to the challenges faced by family and others. It is essential to implement
internventions while there is still motivation and learning capacity. There are
approximately 500 people living in Ireland with HD. (HDA 2012)
Progressive Supranuclear Palsy (PSP) is a progressive brain disorder that causes
serious progressive deterioration with gait and balance along with complex eye
movements and thinking problems. One of the classic symptoms is the inability to
aim the eyes properly. Symptoms may also include personality change, memory
impairment and blurred vision. The cause is a gradual deterioration in the brain cells
in a specific area of the brain known as the brain stem. (parkinsons.ie)
Research in Assistive Technology and Degenerative Neurological Diseases
A literature review was carried out using CINAHL. The key words were AT, Motor
Neuron Disease/Amyotrophic Lateral Sclerosis, Multiple Sclerosis and degenerative
neurological conditions. The searches yielded little results, indicating a vast need for
From the research, assistive technology is described as a means to help persons
with a degenerative condition continue to fulfil meaningful life roles.
A study by Casey (2012) discussed AT and Amyotrophic Lateral Sclerosis (ALS). It
reported that AT may be used to help improve mobility, communicate, perform
activities of daily living and maintain social and professional relationships (Casey
2012). The study showed, while there is limited evidence specifically supporting the
usefulness of an AT clinic for persons with ALS, there is evidence that supports
attendance at a multidisciplinary clinic positively impacting the lives of persons with
ALS, as well as evidence supporting access to AT for persons with ALS. Other
studies showed that if AT is available for persons with ALS, they will use it to stay
connected with family and friends and to discuss important issues (Doyle 2001 &
An article by Souza (2010) investigated powered mobility in the MS population.
Mobility impairments frequently restrict participation in work, family, social,
vocational, and leisure activities. Furthermore, persons with MS often experience
difficulties adapting to the changing and progressive nature of mobility loss,
frequently marked by exacerbations and remissions.
This article cites one of the biggest challenges for professionals and persons with
MS is finding a mobility device that meets the users’ needs and maintains or
increases community participation. Being able to remain active in the community and
also keep their jobs are some of the biggest challenges for persons with MS.
In an overview of AT and MS Blake provides us with practical examples of low tech
and high tech solutions for this client group. In this article they highlight the
importance of selecting the optimal device from the beginning that can . For
individuals with MS, having a single device with which they can learn to use and
become comfortable and that adjusts with the continuum of their disability it a high
In all the research the timing of intervention in noted, it is essential to consider AT
early on in the systematic care of persons in order to maximize the benefits of the
technology. If technology is not thoroughly addressed in the early stages of the
disease process, the person is more likely to have more impairments leading to more
advanced technology needs resulting in delays in recommendations for the AT
evaluation, procurement of, and education with the device. Considering the rapidly
progressive loss in overall function experienced by persons with progressive
neurological disorders, it is essential to provide comprehensive multidisciplinary
care, including AT services in an effective and efficient manner. (Casey 2012)
Computer Access and Degenerative Neurological Diseases
Access to the computer can be one of the first reasons an individual losing motor
function in upper limbs is referred to the ATSS Dept in the CRC. There are many
solutions that can be implemented for the impairments the client report but it is
important to anticipate the deterioration in motor function. It is necessary to
remember that direct access may need to be replaced by switch or other alternatives
within a short period of time. I have a number of MND clients who required one of the
solutions below, but I have educated them on the devices available as the disease
The following are examples of short term solutions for computer access listed in
Key-guards: The addition of a keyguard can be very useful for people with reduced
strength in their hands, tremor, or difficulties with fine motor control. A guard is
placed above the keyboard, with holes to allow access to the individual keys. The
user must insert their finger into the hole to press the keys, thereby avoiding
accidentally hitting nearby keys. This physical separation of the individual keys can
allow a user to be more accurate in their selections. Many people find it difficult to
hold their hands above the keyboard for long periods of time. Keyguards also allow
the user to rest their hands on the keyboard without making any selections. This
helps in managing fatigue when typing. It can be difficult to get a keyguard for an
existing keyboard - most users will purchase a new keyboard supplied with a custom
Mini-keyboards: These small keyboards come in a range of sizes. They are most
useful for people who will be typing with one hand only (e.g. in the case of
hemiplegia, or reduced control in one hand). They reduce the area that the typist
needs to cover, helping to conserve energy and reduce finger stretch. They look very
similar to the keyboards seen on laptops. The main difference between a mini- and
standard keyboard is the absence of a number pad. The keys on these small
keyboards are generally the same size as a standard keyboard but are in closer
proximity to each other. They can be easier to position on a desktop, and are
portable if the user needs to bring them from place to place.
Alternative Mouse Options: Many people can have difficulties with the fine motor
control needed to operate a standard mouse. Additionally it can be difficult for people
to isolate finger movement to use the left- and right-click mouse buttons.
The mouse can be altered to suit a left-handed person via the ‘Control Panel’ on a
computer. Using the Windows ‘Accessibility Features’ it is possible to make the
keyboard perform all of the mouse functions. This can be useful for people who have
reliable typing skills but specific difficulties using the standard.
Touch-Pad Mouse: Many people are familiar with a touch pad mouse from their use
on laptops. These small, touch-sensitive pads are used by moving your finger across
the surface of the mouse. They are available as separate plug-in devices. Touchpad
mice are useful for people with a limited range of physical movement.
Joystick Mouse: This type of mouse is considered a static mouse, in that the mouse
stays in a static position, involving less movement of the user’s hand. A joystick
mouse isolates the mouse movement from the selections made (left click, right click,
double click etc.), as the person needs to release the joystick and then press buttons
for those functions. The ‘Point It Joystick’ has a low profile base with 5
programmable buttons for these functions. The ‘Penny & Giles Joystick Plus’, has a
keyguard for the main buttons, and a useful speed button, allowing the user to
quickly change the mouse movement from fast to slow. This can be useful for people
who use their mouse for fine detail work, or who need to land on small targets on the
For people who drive their chair with a joystick, and who also use a joystick to control
the computer, or even a communication aid, these can be integrated into a single
joystick, mounted on the client’s chair, which can be used for all of these functions.
An example of this is the ‘Genie Joystick’. This can help increase a user’s
independence as they can drive up to their computer, switch the joystick to control
the computer, and then switch back when they are finished. (see below for powered
Head Mouse: Many people do not have adequate hand function to operate a
standard mouse or indeed an alternative mouse which requires a level of hand
function. A head mouse may be a suitable option for these people. A head mouse
can be a difficult piece of equipment to master.
By their very nature progressive neurological diseases cause a rapid deterioration in
a multitude of motor functions. Therefore it is essential we consider the disease
progression and the likely requirement of high tech devices. It is possible to build
more facilities into a device if you start off with a high tech device. This eliminates the
need to learn to use a whole new device, in addition failure with one device may lead
Selection of devices such as a Dynavox or a Tobii can be used via direct access but
as the disease progresses switches and eyegaze can be activated. (See section on
Alternative and Augmentative Communication Devices for further) Switch Use: Many switch options for computer control are available. For many
users, accessing a physical keyboard is either not possible, or inadvisable. Many
software packages will allow a keyboard to be displayed on the screen, removing the
need for a separate keyboard on the desk. The user accesses the keyboard using
Eye-Gaze Control: Options for controlling computers via eye-gaze are considered
for people whose hand movements are extremely limited.
Powered Mobility and Progressive Neurologic Diseases
As we know, mobility impairments frequently restrict participation in work, family,
social, vocational, and leisure activities, therefore it is essential that clients with a
progressive neurological disease are enabled to optimise their quality of life.
Similarly to access methods for computers it is necessary to pre-empt the issues that
are almost guaranteed to arise around standard joystick use due to loss of motor
function in degenerative neurological diseases. The rapid deterioration of motor
function it is a key consideration in ordering the type of joystick. I have experienced
difficulty in getting joysticks retro-fitted to older models powered wheelchairs. If the
therapist had anticipated the need for alternative access when initially prescribing the
powered chair it would have eliminated the issue from arising later in the disease
progression. Therefore when prescribing powered mobility with a joystick I feel it is
necessary to ensure it will have the potential to accommodate one or all of the
R-Net Chin Joystick (P&G Technology): This device is designed for use with the
R-net Compact Joystick. This versatile kit provides a discrete, lightweight chin
solution. Two ‘Gooseneck’ switches may be fixed to the base of the joystick using
the plates provided or mounted discreetly for optimum positioning. Each switch can
be assigned different functions depending on the requirements of the user, e.g. for
use as a horn, power, profile or mode button. The brightly coloured ‘softball’ offers a
comfortable alternative to the traditional, rigid chin knob.
Head Array: This consists of a set of three Egg Switches mounted on a Stealth
Swing Away Headrest that connects to the ClickToGo wheelchair control operating in
Head Array mode. The right hand switch turns on the wheelchair and drives the chair
to the right. It can also optionally be used to change modes between Driving, Seat
function, Lights and External device. The left hand switch drives the chair to the left.
It can also optionally be used to switch off the wheelchair. The “behind the head”
switch is used to drive the chair forwards or backwards. Pressing and holding it will
drive the chair forwards but clicking it once and then pressing and holding it will drive
the chair backwards. The Head Array compensates for accidental switch presses or
releases automatically as a user drives over bumpy pavements. The Heading Lock
ensures that when driving forward the chair does not veer to one side or the other
ClickToGo: This provides effective Powered Wheelchair control using switches. It
gives independent control of mobility to individuals who do not have the requisite
strength, control or co-ordination to use a standard joystick control. The ClickToGo is
operated by single or multiple switches via a scanning interface. The eight direction
indicators are illuminated by ultra-bright LEDs and can be scanned in many different
ways. When a direction is chosen, pressing a switch drives the chair.
Sip/Puff Controls: Sip and puff drives are the solution for those users who aren't
able to use any part of their body to operate a control device on their power
wheelchair. Sip and puff systems are digital non-proportional drives and require quite
a bit of practice by the user to get good at driving. In order to drive with a sip and puff
system the user will either blow into a tube or suck on the tube. Not only do the
wheelchair electronics distinguish between a sip and a puff it, can also recognize the
strength of the sip and puff. A hard sip or puff will mean one thing to the wheelchair
and a soft sip or puff will mean something else. The trick for the user is to get used to
how hard to sip or puff and be consistent with those actions.
Single Switch Controls: This consists of one switch mounted on a Stealth Swing
Away Headrest that connects to the ClickToGo wheelchair control (as described
above) operating in Head Array mode. It can also optionally be used to change
modes between Driving and Seat functions.
Environmental Control Units & Progressive Neurological Diseases
Environmental control is a way of enabling a person to live more independently and
safely in their house or apartment using technology. Environmental control systems
can bring huge benefits to a person with a disability in terms of access, safety and
Depending on what the needs and requirements are environmental control systems
can be simple or advanced. As with all the other areas of AT discussed it is
advisable to ensure the ECU device is switch accessible. For example, a person who
as difficulty using their hall door key can be given an electronic key, which will
release an electric lock when they press it. Similarly a wheelchair user may require
the above solution with the addition of an electric door opener. Another example is
the person who cannot get to the phone quickly. They can be given a hands-free
phone with a remote control so that they can make and receive callas from the
There are a number of infrared transmitters on the market that enable people with a
degenerative condition maintain independent living. Again these devices will require
The following are a list of devices and summary of their uses;
Senior Pilot: This is a remote control with large illuminated keys and a
comprehensive set of transparent symbols which can be placed underneath the key
caps. The unit consist of 14 keys which can be freely assigned and programmed to
control most devices. A large red key at the top of the unit is reserved for the most
frequently used function, such as a service call. A similar key at the bottom turns on
a back light. The Senior Pilot is also switch accessible. A single switch can be used
to activate a scan of the buttons and make selections.
HouseMate Lite: This is a stand-alone switch accessible Infra-red remote control
with auditory feedback using recorded speech. Practical and easy to use HouseMate
can be operated by external switches or directly by pressing the keypad. It records
up to 20 Infra-red commands from other remote controls. It can be programmed to
different scanning options. It is single or two level switch operation.
GEWA Control Prog: This is the most popular Infra-Red transmitter, highly versatile,
simple to use and easy to program. For people who require more than 18 functions,
up to 10 pages or levels can be defined giving access to a maximum of 161
functions. Using levels, each key has a different function depending on what level is
selected. For example you can have one level for the phone, one for the television
control and another for house functions such as lights, window openers etc. Pressing
the level key changes the level. The Control Prog contains a large number of
scanning options and is ideal for people who cannot access keys directly but who
can have the ability to press one or more switches. It is less ideal for those people
with cognitive impairment, but can be stripped back to a simplified format to allow tv
InfraRed mains socket: This is ideal for a person who wishes to be able to turn on
and off an electric heater, table lamp or other device by pressing a key on an
InfraRed transmitter. During installation the socket learns what key to respond to by
pressing the program button on the side of the socket and a key on the remote
control at the same time. Then, whenever that key is pressed the socket will either
switch power on or off to the appliance. Compatible only with GEWA infrared
controls but or those that have been pre-programmed with GEWA codes.
Electric Door Openers: These can be fitted to timber, metal or PVC doors and
mortise locks, rim locks and multi-point locks can be made to open electrically. The
type of door opener and lock required can have a big impact on the cost. Other
important factors include the depth of the reveal around the door, the type of material
used in the wall above the door, location of electric power and the orientation of the
door in relation to the prevailing wind.
Window Opener: This is a small compact chain drive which can be used to open a
bottom hung, top hung or side hung window. The drive is fitted parallel to the window
frame and the chain is connected to the window itself with a bracket and pin. When
the window is closed the chain is rolled up inside the housing and is completely
sealed. When the unit is operated the chain pushes the window open to a maximum
of 10 inches. The window can be manually opened further for cleaning purposes by
removing the bracket pin. The unit requires a 24v power supply, an IR2ML infra-red
receiver and can be operated from any GEWA transmitter.
Videx Door-Entry System: This uses a person’s existing telephone to speak to a
caller at the front door and open it. The system consists of a front door unit and an
interface to the telephone line. When a caller rings the door bell the telephone rings
twice as fast as normal. This allows the occupant to distinguish between a call to the
front door and a normal incoming telephone call. When they answer the phone they
can speak directly with the caller at the door. To let the caller in they press button 9
on the phone. This releases an electric lock and the caller can push open the door.
DuoCom: This is a door-entry system with advanced features. The system consists
of a front door unit and one or more room units. When a person rings the door bell
the occupant answers by pressing the “Answer” button. After speaking with the caller
the occupant can open the door by pressing the “Door Open” button. The electric
lock is released and the caller can push open the door. If an electric door opener is
fitted the door will open and close automatically. For people who have difficulty
speaking three recorded phrases can be used, one for “hello who is it…”, a second
for “please come in.” and a third for “call back later…”. For people who have
difficulty pressing buttons, the DuoCom can be operated by any GEWA transmitter.
The GewaTel 200 is a hands-free telephone that allows a person to make and
receive calls without ever having to pick up the handset. In addition the phone can
be operated by any GEWA transmitter. This feature can be used in a simple way to
allow a person to answer a call quickly by pressing a pendant or it can be used to its
maximum potential and allow a switch user to operate their phone using a PROG 3
or Progress. Other features include being able to build up a telephone number
before making a call, 8 direct dial numbers and battery backup in case of power
Alternative and Augmentative Communication Devices
Degenerative neurological diseases can lead to weakness or loss the muscle
strength involved in production of speech it is necessary to provide clients with the
ability to communicate with family, friends and others on a daily basis.
The following are a list of devices that are suitable for direct access, most of which
can also be adapted to allow switch access or eyegaze access to accommodate loss
Lightwriters: These are small, robust, portable text-to-speech communication aids
specially designed to meet the particular and changing needs of people with speech
loss. Lightwriters are designed to accommodate the wide range of physical
disabilities which may accompany loss of speech, such as poor control, tremor, weak
muscles, spasticity, slow reactions, cognitive limitations, impaired vision and
deafness. Lightwriters have high legibility dual displays, one facing the user and a
second out-facing display allowing natural face-to-face communication. This gives
the user the opportunity to maintain eye contact, facial expression, and body
language with their conversational partner. Unfortunately the new modles of
Lightwriter being manufactured, I discovered, does not offer the option of switch
scanning. The older models do have that option and are still being used within the
Dynawrite: This is a 'type and talk' communication aid for people with strong
literacy skills, motor control and dexterity. It features a standard-size keyboard and
writing enhancement features including word prediction (the wordlist can sit at
various positions around the screen) and flexible abbreviation expansion, where any
letters contained in an abbreviated phrase will trigger the expansion. The DynaWrite
is a dedicated communication aid, ie you can't run any of your own software on it.
There's also a built-in recorded speech facility where you can store over an hour of
your own words or phrases into word banks. The DynaWrite can be used with its
keyboard, or via single and dual-switch scanning. The scanning overlay clips onto
the top of the unit and is available in three key configurations - scanning optimised,
QWERTY or ABC. This is useful because it can accommodate the functional
deterioration without changing device. If a client has a negative experience of failure
with the first device it can create a psychological barrier to trialing and learning to
ECO2: This is an integrated communication aid and computer with a large colour
touchscreen. The user can switch between standard computer mode and
communication aid mode by pressing a single button. In fact, the vocabulary
software can serve as an onscreen keyboard for accessing standard Windows
software. An eye-pointing or eye gaze version of the ECO is also available, called
the ECO point. The ECO point is an eye-gaze access module that 'bolts-on' to the
bottom of Liberator's ECO2 and older Lib 14 communication aids. It enables these
aids to be accessed using eye movement, useful for when direct selection or head
tracking may be difficult. Individuals who use eye-gaze control may have conditions
such as (but not limited too) ALS, Multiple sclerosis. The module itself is purpose
built by Tobii Technology and has two high-definition cameras and over 100 LEDs to
track the user’s eyes. A relatively large 'operational' area that accommodates a
reasonable range of head and body movement.
Tobii C12: This is a computer-based touchscreen communication aid that's suitable
for for a wide range of communication abilities and access methods. It features
Tobii's Communicator software that gives both text and symbol-based
communication, along with email, internet, mobile phone and environmental
capabilities. The Tobii C12 enables text and symbol-based communication. The
SymbolStix symbols set is included, although other symbol sets can be used. An
optional upgrade to Tobii Communicator Premium will provide email, text messaging
and environmental control options. The C12 can also run other Windows compatible
communication software. The C12 is designed for operation via the 12.1 inch (31cm)
resistive touchscreen directly or with a stylus. It's also accessible with one or two
external switches, joystick, trackerball, mouse, headpointer, and eye-gaze via the
optional Tobii CEye unit. Auditory scanning is also possible. The C12 has built-in
infrared environmental controls for controlling a TV, DVD and other household
appliances (with additional equipment required). The two slim batteries that are
supplied can be swapped without turning the device off, and these give about four
hours of continuous use. High capacity batteries are available that give six hours of
use. The device also has a moisture resistant construction. The C12 can be mounted
and used on a wheelchair. An integrated desk stand is included along with a
mounting bracket for Daessy mounting systems. Optional brackets for Vesa and
Rehadapt are available, along with a soft carrying case and a shoulder strap. A built-
in camera enables users to capture images and use them in their communication
Dynavox V and VMAX: The multilingual and durable DynaVox V and Vmax are
designed to meet a broad range of needs based on one’s age and ability. The
functional framework of the V and Vmax and comprehensive features of Series 5
Software make them the solution for individuals of all ages and abilities. It facilitates
communicate with increased audio clarity, voice projection and intelligibility using
enhanced voices that are natural-sounding and easy to understand. It accelerates
communication using rate enhancement techniques like concept-based Phrase
Prediction. It allows customization of the device to suit varying needs, abilities and
access methods, including “eye tracking” or eyegaze.
In summary, these devices give a voice to those who’s disease has left them without
one. It enables them to fulfil the basic need of communication and enhances their
Key Considerations for Best Practice in Equipment Prescription
Following an investigation into practice in the area both clinically and theoretically I
have found there are multiple factors to consider when introducing assistive
technology to an individual with a diagnosis of a degenerative neurological disease.
Many of these are psychosocial, emotional and require a high degree of sensitivity
on the behalf of the AT assessor. Some observations from my own experience and
from the literature highlight the following as key considerations;
1. The timing of intervention is essential in order to maximize the benefits of the
technology. If technology is not thoroughly addressed in the early stages of the
disease process, the person is more likely to have more impairments leading to more
advanced technology needs resulting in delays in recommendations for the AT
evaluation, procurement of, and education with the device.
2. Always ensure any type of AT device can be adapted to meet the deteriorating
functional ability of the individual is essential to maintain interest and participation in
AT. For example, when prescribing powered mobility with a joystick it is necessary to
ensure it will have the potential to accommodate alternative access drives. In
addition, for the prescription of AAC or ECU devices always ensure the device can
The Enable Ireland Certified Assistive Technology Training Course has given me the
opportunity to reflect on my clinical experiences and research in the area of AT and
degenerative neurological conditions. I feel it has allowed me to develop my skills of
assessment and prompted me to think more thoroughly about equipment
prescription for this client group. As a result I will be far more mindful of the key
considerations I identified for any equipment I prescribe to clients with degenerative
References
Souza A, Kelleher A, Cooper R, Cooper RA, Iezzoni LI and Colins DM. Multiple
sclerosis and mobility-relater assistive technology: Sysematic review of literature.
Journal of Rehabilitation Research & Development. Volume 47, Number 3, 2010
Krantz O. Assistive devices utilisation in activities of everyday life – a proposed
framework of understanding a user perspective. Disability and Rehabilitation:
Assistive Technology, 2012; 7(3): 189–198
Showalter Casey K, Creating an assistive technology clinic: The experience of the
Johns Hopkins AT Clinic for patients with ALS. NeuroRehabilitation 28 (2011) 281–
Blake JB & Bodine C. An overview of assistive technology for persons with multiple
sclerosis. Journal of Rehabilitation Research and Developmen. Vol 39 No.2